title: Severe malaria in Battambang Referral Hospital, an area of multidrug resistance in Western-Cambodia: a retrospective analysis of cases from 2006-2009.
abstract: BACKGROUND
  Despite recent malaria containment and control efforts leading to reduced incidence, Cambodia remains endemic for both Plasmodium vivax and multidrug-resistant Plasmodium falciparum malaria. Little has been reported in the peer-reviewed literature regarding the burden of severe malaria (SM) in Cambodia.
  
  
  METHODS
  Medical records for all patients admitted to the Battambang Referral Hospital (BRH) with an admitting or discharge diagnosis of SM from 2006 to 2009 (suspected SM cases) were reviewed. Those meeting the case definition of SM according to retrospective chart review and investigator assessment of probable cases, based on published national guidelines available at the time, were analysed for trends in demographics, mortality and referral patterns.
  
  
  RESULTS
  Of the 537 suspected SM cases at BRH during the study period, 393 (73%) met published WHO criteria for SM infection. Despite limited diagnostic and treatment facilities, overall mortality was 14%, with 7% mortality in children 14 and under, but 19% in adults (60% of cases). Cerebral malaria with coma was relatively rare (17%), but mortality was disproportionately high at 35%. Mean time to hospital presentation was five days (range one to 30 days) after onset of symptoms. While patients with delays in presentation had worse outcomes, there was no excess mortality based on treatment referral times, distance travelled or residence in artemisinin-resistance containment (ARC) Zone 1 compared to Zone 2.
  
  
  CONCLUSIONS
  Despite limitations in diagnosis and treatment, and multiple confounding co-morbidities, mortality rates at BRH were similar to reports from other countries in the region. Interventions to improve access to early diagnosis and effective treatment, combined with modest improvements in intensive care, are likely to reduce mortality further. Patients referred from Zone 1 did not have excess mortality compared to Zone 2 ARC areas. A steep decrease in SM cases and deaths observed in the first half of 2009 has since continued, indicating some success from containment efforts despite the emergence of artemisinin resistance in this area.
authors.affiliation: Department of Immunology & Medicine, Armed Forces Research Institute of Medical Sciences, 315/6 Rajvithi Road, Bangkok 10400, Thailand. chanthapl@afrims.org
authors.forename: Chanthap
authors.initials: C
authors.lastname: Lon
authors.forename: Ans
authors.initials: A
authors.lastname: Timmermans
authors.forename: Nillawan
authors.initials: N
authors.lastname: Buathong
authors.forename: Samon
authors.initials: S
authors.lastname: Nou
authors.forename: Youry
authors.initials: Y
authors.lastname: Se
authors.forename: Ngo
authors.initials: N
authors.lastname: Sitthy
authors.forename: Soklyda
authors.initials: S
authors.lastname: Chann
authors.forename: Somporn
authors.initials: S
authors.lastname: Kraesub
authors.forename: Tippa
authors.initials: T
authors.lastname: Wongstitwilairoong
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Walsh
authors.forename: Stuart
authors.initials: S
authors.lastname: Tyner
authors.forename: Mark
authors.initials: M
authors.lastname: Fukuda
authors.forename: David
authors.initials: D
authors.lastname: Callender
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Sherwood
authors.forename: Lenin
authors.initials: L
authors.lastname: Koy
authors.forename: Mengchour
authors.initials: M
authors.lastname: Char
authors.forename: Delia
authors.initials: D
authors.lastname: Bethell
authors.forename: David
authors.initials: D
authors.lastname: Saunders
mesh_terms: D000293:Adolescent; D000328:Adult; D000962:Antimalarials / Q000627:therapeutic use; D002160:Cambodia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003710:Demography; D004351:Drug Resistance; D005260:Female; D006801:Humans; D016778:Malaria, Falciparum / Q000150:complications / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology*; D016780:Malaria, Vivax / Q000150:complications / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology*; D008297:Male; D010963:Plasmodium falciparum / Q000187:drug effects; D010966:Plasmodium vivax / Q000187:drug effects; D012189:Retrospective Studies; D016019:Survival Analysis; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000962:Antimalarials